4.12 Research as an intervention

Several authors, notably Milton Silverman, Philip Lee and Mia Lydecker have published descriptions and analyses of promotion and its effects, which appear to have been instrumental in improving the quality of promotional material

In 1976 the Silverman team published The Drugging of the Americas, which compared promotion of 40 products by 12 companies in the US and Latin America. Looking at standard, widely used drug compendia, they found that promotional claims were exaggerated, and warnings were limited, minimised or entirely ignored. The findings were summarised in an article published in 1977249 which also notes the enormous media coverage the book received around the world. In 1982, Prescriptions for Death250, reported similar research in a wider range of countries: the USA, the UK, African countries, Indonesia, Malaysia, Singapore, Philippines and Latin America. Similar results were found. The groups’ 1982 article251 reports no readily apparent differences between US and other multinationals, multinationals and other domestic firms, brand and generic companies, or companies from the capitalist or the socialist block. Fieldwork for the third study was carried out in 1984, published in book form in 1986 and summarised in 252. This involved 63 drugs, 1069 different products, 303 companies and 30 countries. They found noticeable differences between the results of their earlier work and the situation in 1983. Companies showed more restraint in describing the value of medicines and more willingness to disclose potential hazards. However, problems still existed, particularly in Latin American countries. The 1992 book Bad Medicine253 presents a more positive picture. Fieldwork for this was done in 1987/8, and included 40 drugs, 1500 products, 400 companies, in the US, UK and 74 developing countries. The authors concluded that most multinationals had improved considerably by the late 1980s. Local and domestic firms were now mainly responsible for inaccurate promotion. Silverman et al.’s books show a clear improvement over time in promotion in developing countries, and it is likely that the books themselves, by drawing international attention to the topic, have been at least partly responsible for this improvement.

CONCLUSION: Publication of descriptions of deceptive promotion can lead to improvements.